Hospital therapy. Diagnosis of chronic bronchitis (CB) (the most important)

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Hospital therapy. Diagnosis of chronic bronchitis (CB) (the most important)

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28. Diagnosis of chronic bronchitis (CB)

Diagnostics. Auscultation reveals hard breathing (with the development of emphysema it can become weakened) and dry rales of a diffuse nature, the timbre of which depends on the caliber of the affected bronchi (wheezing wheezes well heard on exhalation are characteristic of lesions of small bronchi).

With an exacerbation of obstructive bronchitis, shortness of breath increases, the phenomena of respiratory failure increase.

In advanced cases of chronic bronchitis and with the addition of complications, signs of emphysema of the lungs, respiratory and cardiac (right ventricular) insufficiency - decompensated pulmonary heart appear: acrocyanosis, pastosity or swelling of the legs and feet, changes in the nails in the form of watch glasses, and the terminal phalanges of the hands and feet - in in the form of drumsticks, swelling of the cervical veins, pulsation in the epigastric region due to the right ventricle, accent of the II tone in the II intercostal space to the left of the sternum, liver enlargement.

Laboratory and instrumental indicators have a different degree of significance depending on the stage of the process.

X-ray examination of the chest organs is performed in all patients with chronic bronchitis, however, as a rule, there are no changes in the lungs on plain radiographs. There may be a mesh deformation of the lung pattern, due to the development of pneumosclerosis. X-ray examination plays an important role in the diagnosis of complications (acute pneumonia, bronchiectasis) and in the differential diagnosis with diseases with similar symptoms. Bronchography is used only to diagnose bronchiectasis.

Bronchoscopy is of great importance in the diagnosis of chronic bronchitis and its differentiation from diseases that manifest a similar clinical picture. It confirms the presence of an inflammatory process; clarifies the nature of inflammation; reveals functional disorders of the tracheobronchial tree; helps in identifying organic lesions of the bronchial tree.

The study of the function of external respiration is carried out to identify restrictive and obstructive disorders of pulmonary ventilation. According to the spirogram, the Tiffno index and the air velocity indicator - PSDV are calculated.

The joint assessment of bronchial resistance and lung volumes also helps to determine the level of obstruction.

Radiopulmonography using the radioactive isotope 133Xe is performed to detect uneven ventilation associated with obstruction of the small bronchi.

Electrocardiography is necessary to detect hypertrophy of the right ventricle and right atrium developing in pulmonary hypertension.

A clinical blood test reveals secondary erythrocytosis resulting from chronic hypoxia with the development of severe pulmonary insufficiency. "Acute phase" indicators are expressed moderately.

Microbiological examination of sputum and bronchial contents is important to identify the etiology of exacerbation of chronic bronchitis and the choice of antimicrobial therapy.

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